First Vaccine Confidence and Access Index in Argentina: Comparison of Results from 2019 to 2022

"The data suggest that, while confidence in vaccines is not a major issue in Argentina, it is imperative to continue monitoring it, particularly because confidence levels have remained consistently lower than those observed before the pandemic in 2019."

Vaccine uptake is influenced by a combination of barriers to access, social norms, lack of information, diminished disease risk perception, and potential lack of confidence. In light of these issues, these researchers initiated a project in Argentina, a country that faces contrasts in healthcare access based on geographical and socioeconomic factors, despite offering twenty mandatory free vaccines. This article presents and empirically illustrates two concepts about vaccines and the way they are perceived by the Argentinean population and the easiness in accessing vaccination in developing countries. First, the researchers focus on the perceptions of people about vaccines in general and develop a confidence index. Second, they analyse barriers to vaccination, measuring the burden citizens have when they intend to receive immunisation (or as caretakers, trying to comply with the vaccination calendar of children and adolescents). For this second concept, they develop an access index.

The data come from representative annual surveys from Argentina from 2019 to 2022 (each one with approximately 7,000 respondents). The automated telephone surveys aimed for extensive geographic coverage, encompassing urban, peri-urban, and rural areas, while also engaging the young population. This methodology was designed to allow the researchers to describe trends and check for changes in the confidence in vaccines and barriers towards vaccination.

Despite minor year-to-year variations after 2020, the main feature is a drop in confidence between 2019 (95% confidence interval (CI): 93.1-93.8) and 2020 (95% CI: 86.7-87.7), with no sign of recovery in confidence levels thereafter (in 2022, the 95% CI of the index was 85.2-86.6). The components of the index (vaccines are safe, important for children, and effective) all show a similar pattern, indicating a clear "structural break" observed in 2020. Despite this downward trend, an overwhelming majority (about 90%) agree that vaccines are safe, important for children, and effective.

By studying trends by age groups, the main finding is a consistent trend towards less confidence in the 15- to 19-year-old group, which is worrisome, as this group will soon become the generation of caregivers of children in need of timely vaccination.

By 2022, the questionnaire was redesigned following the World Health Organization (WHO)'s Strategic Advisory Group of Experts (SAGE) recommendations, focusing on vaccine uptake challenges, particularly access barriers. This access index is influenced in WHO's dimensions for analysing the behavioural and social drivers of vaccine uptake. These dimensions include information availability, associated costs, ease of accessing vaccination services, material conditions for reaching vaccination centres, experiences of rejection at previous visits, inconvenient opening hours of vaccination centres, waiting times, and success in obtaining vaccination during the last visit.

This new version of the questionnaire resulted in asking questions to the group of caretakers and to the rest of the population. The main finding was that barriers to vaccination tend to affect less educated caretakers, with a steep gradient. The results show an educational gradient potentially related to socioeconomic conditions, which would mean that economically poorer individuals may face greater challenges in accessing vaccinations. In terms of the age of the caretakers, the index is lower (more barriers to access) for those ages 15-20 and 65 and over. Finally, women tend to achieve a better provision of access for children they take care of, which could be related to better information about sites of vaccination.

In reflecting on the findings, the researchers note that confidence levels have remained consistently lower than those observed before the COVID-19 pandemic's arrival. As the survey data were collected in the last months of each year, the 2020 data coincided with the announcement of SARS-CoV-2 vaccine candidates and the upcoming vaccination schedule for this virus. Regrettably, the 2020 questionnaire did not include tools to investigate the reasons behind the drop in confidence, but the data indicate a significant drop in confidence associated with, though not necessarily caused by, the COVID-19 pandemic.

"Perhaps one question that remains to be explored in this context is: what measures can be taken to enhance confidence through public education during a pandemic? A small educational intervention in a specific group could be studied to prepare a broader intervention to foster vaccine confidence in the event of a new pandemic."

In conclusion, "Although additional data (via a more extensive questionnaire or parallel qualitative research) could provide more insights," the researchers contend that their study "makes a significant contribution to understanding the drivers of timely vaccination and identifying population segments that are either less inclined to vaccinate or face greater access difficulties. This information is vital for designing a more effective vaccination system in the country, focusing on strategic location of centers, convenient operating hours, and addressing issues related to the cost of travel to vaccination centers, among other factors."